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P171
P268
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
P168 Ultrastructural Changes in Rhinitis Medicamentosa Stephan Knipping, MD (presenter); Gerrit Goetze; Andreas Riederer, MD Halle/Saale Germany; Munich Germany OBJECTIVES: Topical vasoconstrictors are frequently used in the management of rhinosinusitis. Prolonged application causes rhinitis medicamentosa (RM) due to cytotoxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. METHODS: The aim of this study was to search for morphological changes in RM. RESULTS: For this retrospective study from March 2003 to April 2005, tissue samples of inferior turbinates from 22 patients with RM were taken during nasal surgery. For electron microscopy the samples were preserved in glutaraldehyde. Ultrathin sections were cut and a standardized procedure was carried out. The findings were photodocumented by using a transmission electron microscope. Biopsies from 10 patients without chronic inflammations of nasal mucosa were used as control. The transmission electron microscopic investigations revealed severe epithelial damage resulting in regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Thickness of basal membrane was increased. In the edematous subepithelial region, ultrastructural changes of the endothelial lining such as gaps and ruptures of basal lamina of capillaries were detected. Prominent endothelial cells were conspicuous. CONCLUSIONS: RM is drug-induced damage of human nasal mucosa associated with overuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation of the disturbed mucociliary clearance. Especially endothelial cells and the basal membranes of capillaries revealed ultrastructural changes. This could be the reason of an increased vascular permeability with consecutive interstitial edema. After withdrawal of local vasoconstrictors, topical corticosteroids should be used to decrease swelling of the nasal mucosa.
P169 Uncinectomy: Stammberger or Swing-Door Technique? Vishwanath Puranik, FRCSEd FRCSI DLO (presenter); Amir Sheka, MD Bangor UK OBJECTIVES: Uncinectomy is the first step performed in FESS. A postal questionnaire was sent to all the practising British otorhinolaryngologists from trainees to the consultant. The aim of this study was to determine which technique of Uncinectomy (Stammberger, swing-door) was advocated by the U.K. otorhinolaryngologists in FESS. METHODS: The study consisted of a comprehensively designed questionnaire posted to 932 members of BAOL. Some 615 members completed questionnaires.
RESULTS: The initial question to the surgeons was whether they performed FESS and if the answer was positive, then they could answer the remaining questions in the questionnaire. They were then questioned about the preference of performing Uncinectomy (Stammberger technique, swing-door technique, combined, or no preference). Questions were asked regarding the easiest technique for Uncinectomy, training, and rate of complications. Of the group, 458 members performed FESS on a regular basis. The Stammberger technique is popular among ENT surgeons, and 87 surgeons had no preference for a technique of Uncinectomy; 207 surgeons found the Stammberger technique to be easier and 58 did not answer. None of them encountered any problem with orbit and nasolacrimal duct. Postoperative bleeding was a frequent problem in 9 respondents. CONCLUSIONS: A significant proportion of U.K. otolaryngologists do not have any preferred technique for performing uncinectomy: 18.9% of the surgeons have no preference of technique for Uncinectomy and 21.17% perform either way (Stammberger or swing-door technique). The Stammberger technique is found to be easier according to most surgeons but there is a significant evolution of the swing-door technique. P170 Sinonasal Haemangiopericytoma: A Case Series and Review Yuk-Hui Ng, MBBS (presenter); Jern-lin Leong, MD; Ian Loh, MD; Jacqueline Hwang, MBBS FRCPA; Christopher Hood-Keng Goh, FRCS (Ed & Glas) Singapore Rep of Singapore OBJECTIVES: 1. To study the presentation, behavior, and management of sinonasal haemangiopericytomas encountered in our institution. 2. To compare the outcomes from open surgery vs. endoscopic management of these tumors. METHODS: Through a search of histological records from 2000 to 2005, all cases of sinonasal Haemangiopericytoma were reviewed. RESULTS: For the time period, Four patients were diagnosed with sinonasal Haemangiopericytoma. All four were in patients over the age of 50 with a female to male ratio of 3:1. CT scans were used for preoperative assessment. Of the four, one was managed by open resection while the rest had their tumor removed endoscopically. There were no recurrences in the three years of follow-up. CONCLUSIONS: It is suggested that endoscopic removal should be attempted in cases when the tumor is limited to the nasal cavity. A review of recent literature of this unusual tumor is also presented. P171 Oculomotor Nerve Palsy Caused by Paranasal Sinus Disease Kenji Takasaki, MD (presenter); Kaori Enatsu, MD; Minoru Hara, MD; Hidetaka Kumagami, MD; Haruo Takahashi, MD Nagasaki Japan
OBJECTIVES: To demonstrate three rare cases of isolated oculomotor nerve palsy caused by paranasal-sinus desease. Clinical course and computed tomography (CT) image are documented, and pathogenesis relating to local anatomy is discussed. METHODS: Retrospective case report and review of pertinent literature. RESULTS: Report of three cases of isolated oculomotor nerve palsy caused by paranasal-sinus desease. All the patients complained of double vision and had unilateral disturbance of ocular movement and ptosis, but no visual impairment in opthalmologic examination. In two cases, CT demonstrated soft tissue density (STD) in the posterior ethmoid and the sphenoid sinuses and also inside the ipsilateral anterior clinoid precess (ACP) of sphenoid bone. In the remaining case, CT showed STD in the ethmoid sinus and pneumatization in the ACP. Endoscopic sphenoidectomy was performed on the former two cases, and the last case was treated conservatively with steroid and antibiotics. Their ocular movement returned to normal approximately one month later. In all the cases, CT demonstrated a bony defect at the inferior wall in ACP, which is adjacent to the superior orbital fissure. CONCLUSIONS: Since the oculomotor nerve runs just under the ACP, the authors speculate that compression and/or inflammation through the pneumatized ACP might easily cause isolated oculomotor nerve palsy as in the present cases. P172 Can Strong Perfumes Affect Our Olfactory Thresholds Anne Robinson, MD (presenter); Julian Anthony Gaskin, BMed; Paul C Goodenough; Carl M Philpott, MB ChB MRCS DLO; George E Murty, MD CHB FRCS; Michael Bankart, MD Leicester UK; Leicester UK; Leicester UK; Stowmarket UK; Kirby Muxloe UK; Leicester UK OBJECTIVES: 1. Learn whether strong perfumes affect our olfactory thresholds. METHODS: A level two evidenced-based medicine prospective study was performed. Some 160 subjects were tested (age range 17-65 years). All initially had their olfactory thresholds tested for four odors: phenyethyl alcohol (A⫽roses), glacial acetic acid (B⫽vinegar), mercaptan (C⫽propane), and eucalyptol (D⫽eucalyptus) using a series of modified Doty bottles at logarithmic increasing concentrations. They were then exposed to one of four strong perfumes for two minutes in a facemask and thresholds retested. Four commonly used types of male and female bodysprays were used (impulse and lynx). The first 100 subjects were tested with one type of impulse, a further 20 subjects with a second type of impulse, and then two further sets of 20 with two different types of lynx. Subjects were also tested with a mask with no perfume to exclude a placebo effect. Odor presentation was randomised. Results were analysed using paired t tests.
P269 RESULTS: Strong perfumes do have a negative effect on olfactory thresholds. All olfactory thresholds worsened after been exposed to the strong perfumes of lynx and impulse bodysprays with the strongest effect being on PEA. This effect was independent of the order of presentation of smells A to D and of the perfume used. CONCLUSIONS: Strong perfumes do have a negative effect on olfactory thresholds. All four perfumes tested had their strongest effect on PEA. Patients attending for olfactory threshold testing do need to be advised not to wear strong perfumes as this will affect their results.
P173 Observation of Nasal Cycle Using a Portable Rhinoflowmeter Motofumi Ohki, MD (presenter); Toshio Ogoshi, MD Tokyo Japan OBJECTIVES: Nasal patency changes with the effect of the nasal cycle even in normal subjects. Physiologic mechanisms underlying this cycle are not clear. The activity of sympathetic nerves to the nose is regulated by the central nervous system. Conceivably the nasal cycle could participate in defense against respiratory infection or allergies. Conventional methods for studying the nasal cycle, including rhinomanometry and acoustic rhinometry, impose limitations on location and time of evaluation. The aim of this study is to measure the change of nasal airflow during daytime activity using a recently introduced portable device and to discuss the physiological meaning of the nasal cycle. METHODS: Twenty normal subjects 24 to 77 years old and 10 patients with seasonal allergic rhinitis 19 to 40 years old were recruited for this study. They were fitted with the portable rhinoflowmetric device (Rhinocycle; Rhinometrics, Denmark) continuously measuring nasal air flow for each nostril over 12 daytime hours. RESULTS: No subject complained of discomfort owing to the device. Average nasal cycle duration at normal subjects was 110 minutes, although variation was considerable even in a given subject. In pollen season, the duration of nasal cycle was decreased in patients with seasonal allergic patients (P⬍0.05). CONCLUSIONS: The nasal mucosa shows dynamic change during pollen season in allergic patients and this local change reflects, also, changes in the central nervous system. The portable device proved useful in observing the nasal cycle, as it should in generally studying nasal physiology.
P174 FESS and Caldwell-Luc as Treatment of Antrochoanal Polyps Wilma Teresinha Anselmo-lima, MD PhD (presenter); Ricardo Demarco, MD; Fabiana Valera, MD; Marco Asato, MD; Rodrigo Lima, MD; Virgilio do Prado, MD Ribeira˜o Preto Brazil
SCIENTIFIC POSTERS
Scientific Posters—Wednesday
Otolaryngology-Head and Neck Surgery, Vol 135, No 2S, August 2006
P168 Ultrastructural Changes in Rhinitis Medicamentosa Stephan Knipping, MD (presenter); Gerrit Goetze; Andreas Riederer, MD Halle/Saale Germany; Munich Germany OBJECTIVES: Topical vasoconstrictors are frequently used in the management of rhinosinusitis. Prolonged application causes rhinitis medicamentosa (RM) due to cytotoxic effects. Nasal obstruction is caused by rebound swelling when the decongestive effect has disappeared. METHODS: The aim of this study was to search for morphological changes in RM. RESULTS: For this retrospective study from March 2003 to April 2005, tissue samples of inferior turbinates from 22 patients with RM were taken during nasal surgery. For electron microscopy the samples were preserved in glutaraldehyde. Ultrathin sections were cut and a standardized procedure was carried out. The findings were photodocumented by using a transmission electron microscope. Biopsies from 10 patients without chronic inflammations of nasal mucosa were used as control. The transmission electron microscopic investigations revealed severe epithelial damage resulting in regions with hyperplastic and metaplastic changes. Loss of ciliated cells was observed. Thickness of basal membrane was increased. In the edematous subepithelial region, ultrastructural changes of the endothelial lining such as gaps and ruptures of basal lamina of capillaries were detected. Prominent endothelial cells were conspicuous. CONCLUSIONS: RM is drug-induced damage of human nasal mucosa associated with overuse of topical nasal decongestants. Loss and destruction of ciliated epithelial cells are the morphological correlation of the disturbed mucociliary clearance. Especially endothelial cells and the basal membranes of capillaries revealed ultrastructural changes. This could be the reason of an increased vascular permeability with consecutive interstitial edema. After withdrawal of local vasoconstrictors, topical corticosteroids should be used to decrease swelling of the nasal mucosa.
P169 Uncinectomy: Stammberger or Swing-Door Technique? Vishwanath Puranik, FRCSEd FRCSI DLO (presenter); Amir Sheka, MD Bangor UK OBJECTIVES: Uncinectomy is the first step performed in FESS. A postal questionnaire was sent to all the practising British otorhinolaryngologists from trainees to the consultant. The aim of this study was to determine which technique of Uncinectomy (Stammberger, swing-door) was advocated by the U.K. otorhinolaryngologists in FESS. METHODS: The study consisted of a comprehensively designed questionnaire posted to 932 members of BAOL. Some 615 members completed questionnaires.
RESULTS: The initial question to the surgeons was whether they performed FESS and if the answer was positive, then they could answer the remaining questions in the questionnaire. They were then questioned about the preference of performing Uncinectomy (Stammberger technique, swing-door technique, combined, or no preference). Questions were asked regarding the easiest technique for Uncinectomy, training, and rate of complications. Of the group, 458 members performed FESS on a regular basis. The Stammberger technique is popular among ENT surgeons, and 87 surgeons had no preference for a technique of Uncinectomy; 207 surgeons found the Stammberger technique to be easier and 58 did not answer. None of them encountered any problem with orbit and nasolacrimal duct. Postoperative bleeding was a frequent problem in 9 respondents. CONCLUSIONS: A significant proportion of U.K. otolaryngologists do not have any preferred technique for performing uncinectomy: 18.9% of the surgeons have no preference of technique for Uncinectomy and 21.17% perform either way (Stammberger or swing-door technique). The Stammberger technique is found to be easier according to most surgeons but there is a significant evolution of the swing-door technique. P170 Sinonasal Haemangiopericytoma: A Case Series and Review Yuk-Hui Ng, MBBS (presenter); Jern-lin Leong, MD; Ian Loh, MD; Jacqueline Hwang, MBBS FRCPA; Christopher Hood-Keng Goh, FRCS (Ed & Glas) Singapore Rep of Singapore OBJECTIVES: 1. To study the presentation, behavior, and management of sinonasal haemangiopericytomas encountered in our institution. 2. To compare the outcomes from open surgery vs. endoscopic management of these tumors. METHODS: Through a search of histological records from 2000 to 2005, all cases of sinonasal Haemangiopericytoma were reviewed. RESULTS: For the time period, Four patients were diagnosed with sinonasal Haemangiopericytoma. All four were in patients over the age of 50 with a female to male ratio of 3:1. CT scans were used for preoperative assessment. Of the four, one was managed by open resection while the rest had their tumor removed endoscopically. There were no recurrences in the three years of follow-up. CONCLUSIONS: It is suggested that endoscopic removal should be attempted in cases when the tumor is limited to the nasal cavity. A review of recent literature of this unusual tumor is also presented. P171 Oculomotor Nerve Palsy Caused by Paranasal Sinus Disease Kenji Takasaki, MD (presenter); Kaori Enatsu, MD; Minoru Hara, MD; Hidetaka Kumagami, MD; Haruo Takahashi, MD Nagasaki Japan
OBJECTIVES: To demonstrate three rare cases of isolated oculomotor nerve palsy caused by paranasal-sinus desease. Clinical course and computed tomography (CT) image are documented, and pathogenesis relating to local anatomy is discussed. METHODS: Retrospective case report and review of pertinent literature. RESULTS: Report of three cases of isolated oculomotor nerve palsy caused by paranasal-sinus desease. All the patients complained of double vision and had unilateral disturbance of ocular movement and ptosis, but no visual impairment in opthalmologic examination. In two cases, CT demonstrated soft tissue density (STD) in the posterior ethmoid and the sphenoid sinuses and also inside the ipsilateral anterior clinoid precess (ACP) of sphenoid bone. In the remaining case, CT showed STD in the ethmoid sinus and pneumatization in the ACP. Endoscopic sphenoidectomy was performed on the former two cases, and the last case was treated conservatively with steroid and antibiotics. Their ocular movement returned to normal approximately one month later. In all the cases, CT demonstrated a bony defect at the inferior wall in ACP, which is adjacent to the superior orbital fissure. CONCLUSIONS: Since the oculomotor nerve runs just under the ACP, the authors speculate that compression and/or inflammation through the pneumatized ACP might easily cause isolated oculomotor nerve palsy as in the present cases. P172 Can Strong Perfumes Affect Our Olfactory Thresholds Anne Robinson, MD (presenter); Julian Anthony Gaskin, BMed; Paul C Goodenough; Carl M Philpott, MB ChB MRCS DLO; George E Murty, MD CHB FRCS; Michael Bankart, MD Leicester UK; Leicester UK; Leicester UK; Stowmarket UK; Kirby Muxloe UK; Leicester UK OBJECTIVES: 1. Learn whether strong perfumes affect our olfactory thresholds. METHODS: A level two evidenced-based medicine prospective study was performed. Some 160 subjects were tested (age range 17-65 years). All initially had their olfactory thresholds tested for four odors: phenyethyl alcohol (A⫽roses), glacial acetic acid (B⫽vinegar), mercaptan (C⫽propane), and eucalyptol (D⫽eucalyptus) using a series of modified Doty bottles at logarithmic increasing concentrations. They were then exposed to one of four strong perfumes for two minutes in a facemask and thresholds retested. Four commonly used types of male and female bodysprays were used (impulse and lynx). The first 100 subjects were tested with one type of impulse, a further 20 subjects with a second type of impulse, and then two further sets of 20 with two different types of lynx. Subjects were also tested with a mask with no perfume to exclude a placebo effect. Odor presentation was randomised. Results were analysed using paired t tests.
P269 RESULTS: Strong perfumes do have a negative effect on olfactory thresholds. All olfactory thresholds worsened after been exposed to the strong perfumes of lynx and impulse bodysprays with the strongest effect being on PEA. This effect was independent of the order of presentation of smells A to D and of the perfume used. CONCLUSIONS: Strong perfumes do have a negative effect on olfactory thresholds. All four perfumes tested had their strongest effect on PEA. Patients attending for olfactory threshold testing do need to be advised not to wear strong perfumes as this will affect their results.
P173 Observation of Nasal Cycle Using a Portable Rhinoflowmeter Motofumi Ohki, MD (presenter); Toshio Ogoshi, MD Tokyo Japan OBJECTIVES: Nasal patency changes with the effect of the nasal cycle even in normal subjects. Physiologic mechanisms underlying this cycle are not clear. The activity of sympathetic nerves to the nose is regulated by the central nervous system. Conceivably the nasal cycle could participate in defense against respiratory infection or allergies. Conventional methods for studying the nasal cycle, including rhinomanometry and acoustic rhinometry, impose limitations on location and time of evaluation. The aim of this study is to measure the change of nasal airflow during daytime activity using a recently introduced portable device and to discuss the physiological meaning of the nasal cycle. METHODS: Twenty normal subjects 24 to 77 years old and 10 patients with seasonal allergic rhinitis 19 to 40 years old were recruited for this study. They were fitted with the portable rhinoflowmetric device (Rhinocycle; Rhinometrics, Denmark) continuously measuring nasal air flow for each nostril over 12 daytime hours. RESULTS: No subject complained of discomfort owing to the device. Average nasal cycle duration at normal subjects was 110 minutes, although variation was considerable even in a given subject. In pollen season, the duration of nasal cycle was decreased in patients with seasonal allergic patients (P⬍0.05). CONCLUSIONS: The nasal mucosa shows dynamic change during pollen season in allergic patients and this local change reflects, also, changes in the central nervous system. The portable device proved useful in observing the nasal cycle, as it should in generally studying nasal physiology.
P174 FESS and Caldwell-Luc as Treatment of Antrochoanal Polyps Wilma Teresinha Anselmo-lima, MD PhD (presenter); Ricardo Demarco, MD; Fabiana Valera, MD; Marco Asato, MD; Rodrigo Lima, MD; Virgilio do Prado, MD Ribeira˜o Preto Brazil
SCIENTIFIC POSTERS
Scientific Posters—Wednesday